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Pancreatic Neoplasms: HELP
Articles by Alice C. Wei
Based on 17 articles published since 2009
(Why 17 articles?)
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Between 2009 and 2019, A. C. Wei wrote the following 17 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Clinical Trial FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. 2018

Conroy, Thierry / Hammel, Pascal / Hebbar, Mohamed / Ben Abdelghani, Meher / Wei, Alice C / Raoul, Jean-Luc / Choné, Laurence / Francois, Eric / Artru, Pascal / Biagi, James J / Lecomte, Thierry / Assenat, Eric / Faroux, Roger / Ychou, Marc / Volet, Julien / Sauvanet, Alain / Breysacher, Gilles / Di Fiore, Frédéric / Cripps, Christine / Kavan, Petr / Texereau, Patrick / Bouhier-Leporrier, Karine / Khemissa-Akouz, Faiza / Legoux, Jean-Louis / Juzyna, Béata / Gourgou, Sophie / O'Callaghan, Christopher J / Jouffroy-Zeller, Claire / Rat, Patrick / Malka, David / Castan, Florence / Bachet, Jean-Baptiste / Anonymous2681306. ·From the Institut de Cancérologie de Lorraine and Université de Lorraine (T.C.) and Centre Hospitalier Universitaire (L.C.), Nancy, Hôpital Beaujon and University Paris VII, Clichy (P.H., A.S.), Hôpital Huriez, Lille (M.H.), Centre Paul Strauss, Strasbourg (M.B.A.), Institut Paoli-Calmettes, Marseille (J.-L.R.), Centre Antoine-Lacassagne, Nice (E.F.), Hôpital Jean-Mermoz, Lyon (P.A.), Hôpital Trousseau, Tours (T.L.), Centre Hospitalier Universitaire de Saint-Eloi (E.A.) and Institut du Cancer de Montpellier-Val d'Aurelle, Université de Montpellier (M.Y., S.G., F.C.), Montpellier, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon (R.F.), Centre Hospitalier Universitaire Robert Debré, Reims (J.V.), Hôpital Louis Pasteur, Colmar (G.B.), Normandie University, Rouen University Hospital, Rouen (F.D.F.), Hôpital Layné, Mont-de-Marsan (P.T.), Centre Hospitalier Universitaire Côte de Nacre, Caen (K.B.-L.), Hôpital Saint-Jean, Perpignan (F.K.-A.), Centre Hospitalier Régional, Orléans (J.-L.L.), R&D Unicancer (B.J., C.J.-Z.) and Sorbonne Université, Hôpitaux Universitaires Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris (J.-B.B.), Paris, Gustave Roussy, Université Paris-Saclay, Villejuif (D.M.), and Centre Hospitalier Universitaire, Dijon (P.R.) - all in France · and the Princess Margaret Cancer Centre, Toronto (A.C.W.), Kingston General Hospital (J.J.B.) and the Canadian Cancer Trials Group, Queen's University (C.J.O.), Kingston, ON, the Ottawa Health Research Institute, Ottawa (C.C.), and Segal Cancer Centre, Jewish General Hospital, Montreal (P.K.) - all in Canada. ·N Engl J Med · Pubmed #30575490.

ABSTRACT: BACKGROUND: Among patients with metastatic pancreatic cancer, combination chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) leads to longer overall survival than gemcitabine therapy. We compared the efficacy and safety of a modified FOLFIRINOX regimen with gemcitabine as adjuvant therapy in patients with resected pancreatic cancer. METHODS: We randomly assigned 493 patients with resected pancreatic ductal adenocarcinoma to receive a modified FOLFIRINOX regimen (oxaliplatin [85 mg per square meter of body-surface area], irinotecan [180 mg per square meter, reduced to 150 mg per square meter after a protocol-specified safety analysis], leucovorin [400 mg per square meter], and fluorouracil [2400 mg per square meter] every 2 weeks) or gemcitabine (1000 mg per square meter on days 1, 8, and 15 every 4 weeks) for 24 weeks. The primary end point was disease-free survival. Secondary end points included overall survival and safety. RESULTS: At a median follow-up of 33.6 months, the median disease-free survival was 21.6 months in the modified-FOLFIRINOX group and 12.8 months in the gemcitabine group (stratified hazard ratio for cancer-related event, second cancer, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.73; P<0.001). The disease-free survival rate at 3 years was 39.7% in the modified-FOLFIRINOX group and 21.4% in the gemcitabine group. The median overall survival was 54.4 months in the modified-FOLFIRINOX group and 35.0 months in the gemcitabine group (stratified hazard ratio for death, 0.64; 95% CI, 0.48 to 0.86; P=0.003). The overall survival rate at 3 years was 63.4% in the modified-FOLFIRINOX group and 48.6% in the gemcitabine group. Adverse events of grade 3 or 4 occurred in 75.9% of the patients in the modified-FOLFIRINOX group and in 52.9% of those in the gemcitabine group. One patient in the gemcitabine group died from toxic effects (interstitial pneumonitis). CONCLUSIONS: Adjuvant therapy with a modified FOLFIRINOX regimen led to significantly longer survival than gemcitabine among patients with resected pancreatic cancer, at the expense of a higher incidence of toxic effects. (Funded by R&D Unicancer and others; ClinicalTrials.gov number, NCT01526135 ; EudraCT number, 2011-002026-52 .).

2 Clinical Trial Survival Following Resection of Intra- and Extra-Hepatic Metastases from Colorectal Cancer: A Phase II Trial. 2016

Wei, Alice C / Coburn, Natalie G / Devitt, Katharine S / Serrano, Pablo E / Moulton, Carol-Anne / Cleary, Sean P / Law, Calvin / Moore, Malcolm J / Gallinger, Steven. ·Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. Alice.Wei@uhn.ca. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. · Department of Surgery, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. · Department of Surgery, University of Toronto, Toronto, Canada. · Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada. · Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. · Hepatobiliary & Pancreatic Surgical Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada. · Department of Surgery, McMaster University, Hamilton, Ontario, Canada. · BC Cancer Agency, Vancouver, British Columbia, Canada. ·Ann Surg Oncol · Pubmed #27027312.

ABSTRACT: PURPOSE: Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC. METHODS: A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods. RESULTS: Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively. CONCLUSIONS: Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.

3 Clinical Trial Quality of life in a prospective, multicenter phase 2 trial of neoadjuvant full-dose gemcitabine, oxaliplatin, and radiation in patients with resectable or borderline resectable pancreatic adenocarcinoma. 2014

Serrano, Pablo E / Herman, Joseph M / Griffith, Kent A / Zalupski, Mark M / Kim, Edward J / Bekaii-Saab, Tanios S / Ben-Josef, Edgar / Dawson, Laura A / Ringash, Jolie / Wei, Alice C. ·Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Center for Cancer Biostatistics, Biostatistics Unit, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. · Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. · Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio. · Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada. · Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. · Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: alice.wei@uhn.ca. ·Int J Radiat Oncol Biol Phys · Pubmed #25104069.

ABSTRACT: PURPOSE: To determine the health-related quality of life (QOL) during and after neoadjuvant chemoradiation therapy and surgery for patients with pancreatic adenocarcinoma. METHODS AND MATERIALS: Participants of a prospective, phase 2 multi-institutional trial treated with neoadjuvant chemoradiation followed by surgery completed QOL questionnaires (European Organization for Research and Treatment in Cancer Quality of Life Questionnaire version 3.0 [EORTC-QLQ C30], EORTC-Pancreatic Cancer module [EORTC-PAN 26], and Functional Assessment of Cancer Therapy Hepatobiliary and Pancreatic subscale [FACT-Hep]) at baseline, after 2 cycles of neoadjuvant therapy, after surgery, at 6 months from initiation of therapy, and at 6-month intervals for 2 years. Mean scores were compared with baseline. A change >10% was considered a minimal clinically important difference. RESULTS: Of 71 participants in the trial, 55 were eligible for QOL analysis. Compliance ranged from 32% to 74%. The EORTC-QLQ C30 global QOL did not significantly decline after neoadjuvant therapy, whereas the Functional Assessment of Cancer Therapy global health measure showed a statistically, but not clinically significant decline (-8, P=.02). This was in parallel with deterioration in physical functioning (-14.1, P=.001), increase in diarrhea (+16.7, P=.044), and an improvement in pancreatic pain (-13, P=.01) as per EORTC-PAN 26. Because of poor patient compliance in the nonsurgical group, long-term analysis was performed only from surgically resected participants (n=36). Among those, global QOL returned to baseline levels after 6 months, remaining near baseline through the 24-month visit. CONCLUSIONS: The study regimen consisting of 2 cycles of neoadjuvant therapy was completed without a clinically significant QOL deterioration. A transient increase in gastrointestinal symptoms and a decrease in physical functioning were seen after neoadjuvant chemoradiation. In those patients who underwent surgical resection, most domains returned back to baseline levels by 6 months.

4 Clinical Trial A multi-institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. 2013

Kim, Edward J / Ben-Josef, Edgar / Herman, Joseph M / Bekaii-Saab, Tanios / Dawson, Laura A / Griffith, Kent A / Francis, Isaac R / Greenson, Joel K / Simeone, Diane M / Lawrence, Theodore S / Laheru, Daniel / Wolfgang, Christopher L / Williams, Terence / Bloomston, Mark / Moore, Malcolm J / Wei, Alice / Zalupski, Mark M. ·Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA. ·Cancer · Pubmed #23720019.

ABSTRACT: BACKGROUND: The purpose of this study was to evaluate preoperative treatment with full-dose gemcitabine, oxaliplatin, and radiation therapy (RT) in patients with localized pancreatic cancer. METHODS: Eligibility included confirmation of adenocarcinoma, resectable or borderline resectable disease, a performance status ≤2, and adequate organ function. Treatment consisted of two 28-day cycles of gemcitabine (1 g/m(2) over 30 minutes on days 1, 8, and 15) and oxaliplatin (85 mg/m(2) on days 1 and 15) with RT during cycle 1 (30 Gray [Gy] in 2-Gy fractions). Patients were evaluated for surgery after cycle 2. Patients who underwent resection received 2 cycles of adjuvant chemotherapy. RESULTS: Sixty-eight evaluable patients received treatment at 4 centers. By central radiology review, 23 patients had resectable disease, 39 patients had borderline resectable disease, and 6 patients had unresectable disease. Sixty-six patients (97%) completed cycle 1 with RT, and 61 patients (90%) completed cycle 2. Grade ≥3 adverse events during preoperative therapy included neutropenia (32%), thrombocytopenia (25%), and biliary obstruction/cholangitis (14%). Forty-three patients underwent resection (63%), and complete (R0) resection was achieved in 36 of those 43 patients (84%). The median overall survival was 18.2 months (95% confidence interval, 13-26.9 months) for all patients, 27.1 months (95% confidence interval, 21.2-47.1 months) for those who underwent resection, and 10.9 months (95% confidence interval, 6.1-12.6 months) for those who did not undergo resection. A decrease in CA 19-9 level after neoadjuvant therapy was associated with R0 resection (P = .02), which resulted in a median survival of 34.6 months (95% confidence interval, 20.3-47.1 months). Fourteen patients (21%) are alive and disease free at a median follow-up of 31.4 months (range, 24-47.6 months). CONCLUSIONS: Preoperative therapy with full-dose gemcitabine, oxaliplatin, and RT was feasible and resulted in a high percentage of R0 resections. The current results are particularly encouraging, because the majority of patients had borderline resectable disease.

5 Article Management and surveillance of non-functional pancreatic neuroendocrine tumours: Retrospective review. 2019

Yohanathan, Lavanya / Dossa, Fahima / St Germain, Amelie Tremblay / Golbafian, Faegheh / Moulton, Carol-Anne / McGilvray, Ian D / Greig, Paul D / Serra, Stefano / Wei, Alice C / Jhaveri, Kartik S / Gallinger, Steve / Cleary, Sean P. ·Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA. · Division of General Surgery, University of Toronto, Toronto, ON, Canada. · Department of Surgery, Hotel-Dieu De Levis, Levis, QC, Canada. · Department of Family Medicine, London, ON, Canada. · Division of General Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada. · Department of Pathology, University Health Network/University of Toronto, Canada. · Department of Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada. · Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada. · Division of General Surgery, University of Toronto, Toronto, ON, Canada; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada. Electronic address: cleary.sean@mayo.edu. ·Pancreatology · Pubmed #30803874.

ABSTRACT: BACKGROUND: /Objective. To determine the outcomes of a non-operative management approach for sporadic, small, non-functional pancreatic neuroendocrine tumours. METHODS: A retrospective chart review of patients with non-functional pancreatic neuroendocrine tumours initially managed non-operatively at a single institution was performed. Patients were identified through a search of radiologic reports, and individuals with ≥2 cross-sectional imaging studies performed >6 months apart from Jan. 1, 2000 to Dec. 31, 2013 were included. Data on tumour size, radiologic characteristics at diagnosis, interval radiologic growth, and surgical outcomes were recorded. RESULTS: Over the thirteen-year study period, 95 patients met inclusion criteria and were followed radiologically for a median of 36 months (18-69 months). Median initial tumour size on first imaging was 14.0 mm (IQR 10-19 mm). Median overall tumour growth rate was 0.03 mm/month (IQR: 0.00-0.14 mm/month). There was no significant relationship between initial tumour size and growth rate for tumours ≤ 2 cm or for lesions between 2 and 4 cm. Thirteen (14%) patients initially managed non-operatively underwent resection during the follow-up period. Reasons for surgery included interval tumour growth, patient anxiety or preference, or diagnostic uncertainty. Median time to surgery was 14 months (IQR 8-19 months). No patients progressed beyond resectability or developed metastatic disease during the observation period. CONCLUSION: For patients with sporadic, small, non-functional pancreatic neuroendocrine tumours, radiologic surveillance appears to be a safe initial approach to management.

6 Article Changes in preoperative endoscopic and percutaneous bile drainage in patients with periampullary cancer undergoing pancreaticoduodenectomy in Ontario: effect on clinical practice of a randomized trial. 2018

Kagedan, D J / Mosko, J D / Dixon, M E / Karanicolas, P J / Wei, A C / Goyert, N / Li, Q / Mittmann, N / Coburn, N G. ·Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON. · Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON. · Faculty of Medicine, University of Toronto, Toronto, ON. · Sunnybrook Health Sciences Centre, Toronto, ON. · Institute of Health Policy, Management, and Evaluation, Toronto, ON. · Princess Margaret Cancer Centre, University Health Network, Toronto, ON. · Institute for Clinical Evaluative Sciences, Toronto, ON. · Health Outcomes and PharmacoEconomic Research Centre, Toronto, ON. ·Curr Oncol · Pubmed #30464694.

ABSTRACT: Background: In 2010, a multicentre randomized controlled trial reported increased postoperative complications in pancreaticoduodenectomy (pde) patients undergoing preoperative biliary decompression (pbd). We evaluated the effect of that publication on rates of pbd at the population level. Methods: This retrospective observational cohort study identified patients undergoing pde for malignancy, 2005-2013, linking them with administrative health care databases covering medical services for a population of 13.5 million. Patients undergoing pbd within 6 weeks before their surgery were identified using physician billing codes and were divided into those undergoing pde before and after article publication, with a 6-month washout period. Chi-square tests were used to compare rates of pbd. Results: Of 1997 pde patients identified, 963 underwent surgery before article publication, and 911, after (123 during the washout period). The rate of pbd was 47.5% before publication, and 41.6% after ( Conclusions: Rates of pbd have declined a small, but significant, amount after randomized trial publication. Persistence of pbd might relate to suboptimal knowledge translation, the role of pbd in diagnosis of periampullary malignancy, and treatment of complications (cholangitis, severe hyperbilirubinemia) or anticipation of delay from diagnosis to surgery. The nadir in pbd rates after article publication and the subsequent rise suggest an element of transience in the effect of article publication on clinical practice. Further investigation into the reasons for persistent pbd is needed.

7 Article Effect of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas after Pancreaticoduodenectomy. 2016

Serrano, Pablo E / Kim, Dowan / Kim, Peter T / Greig, Paul D / Moulton, Carol-Anne / Gallinger, Steven / Wei, Alice C / Cleary, Sean P. ·Department of Surgery, McMaster University, Hamilton, Canada. ·Am Surg · Pubmed #28234183.

ABSTRACT: Pancreatic fistula (PF) is common after pancreaticoduodenectomy (PD). Its effect on recurrence and survival is not known. Retrospective study of patients undergoing PD for periampullary adenocarcinomas (2000-2012). Standard statistical analyses were performed to determine the impact of PF on disease-free survival (DFS) and overall survival (OS). There were 634 PDs (pancreatic adenocarcinoma: 347, other periampullary adenocarcinomas: 287). Any-grade PF developed in 81/634 (13%). Perioperative mortality rate was 1.7 per cent (11/634), higher in patients with PF (10 vs 0.5%, P < 0.001). In multivariable analysis, PF significantly reduced DFS in pancreatic [hazard ratio (HR) = 1.6, 95% confidence-interval (CI): 1.1-2.6, P = 0.043] but not in other periampullary adenocarcinomas [HR = 1.3 (95% CI: 0.8-2.2), P = 0.45]. Positive lymph nodes, margins, and high-grade histology were associated with decreased DFS and OS. Adjuvant therapy was associated with improved OS in pancreatic [HR = 0.7 (95% CI: 0.5-0.9), P = 0.02] but not in other periampullary adenocarcinomas [HR = 1.14 (95% CI: 0.8-1.7), P = 0.49]. PF did not alter OS in either group. After PD, PF is associated with decreased DFS in pancreatic but not in other periampullary adenocarcinomas. This decrease DFS did not alter OS. Tumor grade, lymph nodes, and resection margin status are associated with DFS and OS.

8 Article Time-to-Surgery and Survival Outcomes in Resectable Colorectal Liver Metastases: A Multi-Institutional Evaluation. 2016

Leal, Julie N / Bressan, Alexsander K / Vachharajani, Neeta / Gonen, Mithat / Kingham, T Peter / D'Angelica, Michael I / Allen, Peter J / DeMatteo, Ronald P / Doyle, Majella B M / Bathe, Oliver F / Greig, Paul D / Wei, Alice / Chapman, William C / Dixon, Elijah / Jarnagin, William R. ·Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. · Department of Surgery, University of Calgary and Foothills Medical Center, Calgary, Alberta, Canada. · Department of Surgery, Washington University in St Louis, St Louis, MO. · Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY. · Department of Surgery, Hepatobiliary and Pancreatic Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Department of Surgery, Hepatobiliary and Pancreatic Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. · Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: jarnagiw@mskcc.org. ·J Am Coll Surg · Pubmed #27113514.

ABSTRACT: BACKGROUND: Resection of colorectal liver metastases (CRLM) is associated with improved survival; however, the impact of time to resection on survival is unknown. The current multi-institutional study sought to evaluate the influence of time from diagnosis (Dx) to resection (Rx) on survival outcomes among patients with resectable, metachronous CRLM and to compare practice patterns across hospitals. STUDY DESIGN: Medical records of patients with ≤4 metachronous CRLM treated with surgery were reviewed and analyzed retrospectively. Time from Dx to Rx was analyzed as a continuous variable and also dichotomized into 2 groups (group 1: Dx to Rx <3 months and group 2: Dx to Rx ≥3 months) for additional analysis. Survival time distributions after resection were estimated using the Kaplan-Meier method. Between-group univariate comparisons were based on the log-rank test and multivariable analysis was done using Cox proportional hazards model. RESULTS: From 2000 to 2010, six hundred and twenty-six patients were identified. Type of initial referral (p < 0.0001) and use of neoadjuvant (p = 0.04) and/or adjuvant (p < 0.0001) chemotherapy were significantly different among hospitals. Patients treated with neoadjuvant chemotherapy (n = 108) and those with unresectable disease at laparotomy (n = 5) were excluded from final evaluation. Median overall survival and recurrence-free survival were 74 months (range 63.8 to 84.2 months) and 29 months (range 23.9 to 34.1 months), respectively. For the entire cohort, longer time from Dx to Rx was independently associated with shorter overall survival (hazard ratio = 1.12; 95% CI, 1.06-1.18; p < 0.0001), but not recurrence-free survival. Median overall survival for group 1 was 76 months (range 62.0 to 89.2 months) vs 58 months (range 34.3 to 81.7 months) in group 2 (p = 0.10). Among patients with available data pertaining to adjuvant chemotherapy (N = 457; 318 treated and 139 untreated), overall survival (87 months [range 71.2 to 102.8 months] vs 48 months [range 25.3 to 70.7 months]; p <0.0001), and recurrence-free survival (33 months [range 25.3 to 40.7 months] vs 22 months [range 14.5 to 29.5 months]; p = 0.05) were improved significantly. CONCLUSIONS: In select patients undergoing initial resection for CRLM, longer time from Dx to Rx is independently associated with worse overall survival. In addition, despite uniform disease characteristics, practice patterns related to definitely resectable CRLM vary significantly across hospitals.

9 Article Improved long-term outcomes after resection of pancreatic adenocarcinoma: a comparison between two time periods. 2015

Serrano, Pablo E / Cleary, Sean P / Dhani, Neesha / Kim, Peter T W / Greig, Paul D / Leung, Kenneth / Moulton, Carol-Anne / Gallinger, Steven / Wei, Alice C. ·Department of Surgery, McMaster University, Hamilton, ON, Canada. ·Ann Surg Oncol · Pubmed #25348784.

ABSTRACT: BACKGROUND: Despite reduced perioperative mortality and routine use of adjuvant therapy following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), improvement in long-term outcome has been difficult to ascertain. This study compares outcomes in patients undergoing resection for PDAC within a single, high-volume academic institution over two sequential time periods. METHODS: Retrospective review of patients with resected PDAC, in two cohorts: period 1 (P1), 1991-2000; and period 2 (P2), 2001-2010. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine prognostic factors associated with long-term survival. Survival was evaluated using Kaplan-Meier analyses. RESULTS: A total of 179 pancreatectomies were performed during P1 and 310 during P2. Perioperative mortality was 6.7 % (12/179) in P1 and 1.6 % (5/310) in P2 (p = 0.003). P2 had a greater number of lymph nodes resected (17 [0-50] vs. 7 [0-31]; p < 0.001), and a higher lymph node positivity rate (69 % [215/310] vs. 58 % [104/179]; p = 0.021) compared with P1. The adjuvant therapy rate was 30 % (53/179) in P1 and 63 % (195/310) in P2 (p < 0.001). By multivariate analysis, node and margin status, tumor grade, adjuvant therapy, and time period of resection were independently associated with overall survival (OS) for both time periods. Median OS was 16 months (95 % confidence interval [CI] 14-20) in P1 and 27 months (95 % CI 24-30) in P2 (p < 0.001). CONCLUSIONS: Factors associated with improved long-term survival remain comparable over time. Short- and long-term survival for patients with resected PDAC has improved over time due to decreased perioperative mortality and increased use of adjuvant therapy, although the proportion of 5-year survivors remains small.

10 Article Risk factors associated with recurrence in patients with solid pseudopapillary tumors of the pancreas. 2014

Serrano, Pablo E / Serra, Stefano / Al-Ali, Hassan / Gallinger, Steven / Greig, Paul D / McGilvray, Ian D / Moulton, Carol-Anne / Wei, Alice C / Cleary, Sean P. ·Department of Surgery, McMaster University. Hamilton, Canada. serrano@mcmaster.ca. ·JOP · Pubmed #25435571.

ABSTRACT: CONTEXT: Solid pseudopapillary tumors (SPT) are rare, generally low grade pancreatic neoplasms that occasionally display malignant behavior. OBJECTIVE: To analyze the clinical and pathological features associated with increased risk of recurrence of SPT. METHODS: Cohort study of patients with SPT who underwent resection of the primary tumor and in selected cases resection of metastatic disease from 1999-2013 at a single tertiary care Hepatopancreatobiliary center. Risk factors for recurrence were statistically analyzed. RESULTS: There were 32 patients. The mean age was 35.65 years (standard deviation: 12.26), 26/32, 81.25% were female. Median size of resected tumors was 4.7 cm (1.1-14.5). Most were solid and cystic (22/32, 68.75%), encapsulated (27/32, 84.4%) and located in the pancreatic body or tail (22/32, 68.75%). All displayed strong β-catenin, cyclin D1, CD56, and progesterone receptor staining with loss of E-cadherin. Most stained positive for vimentin (15/16, 93.75%) and CD10 (17/18, 94.4%). Median follow-up was 43 months (range: 3-207); 3/32, 9.38% recurred (all after 5-years from curative resection) and 1 died by the end of the study period, 11 years after diagnosis. Patients who developed recurrences (n=3) more commonly had synchronous metastases at presentation (P=0.006), lymphovascular invasion (P=0.04) and invasion of tumor capsule (P=0.08) compared to those who did not have disease recurrence. CONCLUSIONS: Lymphovascular invasion, synchronous metastases and local invasion of tumor capsule are associated with aggressive behavior. Since recurrences may occur >5 years from resection, this high-risk group should undergo extended follow-up. Progression and recurrence is slow, therefore, resection of liver metastases can offer long-term survival.

11 Article Aberrant right hepatic artery in pancreaticoduodenectomy for adenocarcinoma: impact on resectability and postoperative outcomes. 2014

Kim, Peter T W / Temple, Sara / Atenafu, Eshetu G / Cleary, Sean P / Moulton, Carol-Anne / McGilvray, Ian D / Gallinger, Steven / Greig, Paul D / Wei, Alice C. ·Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. ·HPB (Oxford) · Pubmed #23782313.

ABSTRACT: OBJECTIVES: An aberrant right hepatic artery (aRHA) may pose technical and oncologic challenges during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA) as a result of its proximity to the head of the pancreas. The aim of this study was to assess the impact of an aRHA on resectability, and perioperative and oncologic outcomes after PD for PA. METHODS: An 11-year retrospective cohort study was conducted. A total of 289 patients with PA scheduled for PD with intent for resection were included in the study. RESULTS: Of 289 patients, 249 underwent PD and 40 were found to have unresectable tumours. Incidences of aRHA in the resectable (14.9%) and unresectable (7.5%) groups were similar (P = 0.2); the main reasons for aborting PD were not directly related to the presence of an aRHA. In patients who underwent resection, complications occurred more frequently in the standard PD group (41.5% versus 24.3%; P = 0.04), but there was no difference in rates of positive margin (R1) resection (10.8% versus 16.0%; P = 0.4) or median overall survival (17 months versus 23 months; P = 0.1) between patients with and without an aRHA. CONCLUSIONS: The presence of an aRHA in patients with PA does not affect resectability. In patients with resectable tumours, the presence of an aRHA does not increase morbidity or R1 resection rates and does not impact on overall survival.

12 Article Hormone profiling, WHO 2010 grading, and AJCC/UICC staging in pancreatic neuroendocrine tumor behavior. 2013

Morin, Emilie / Cheng, Sonia / Mete, Ozgur / Serra, Stefano / Araujo, Paula B / Temple, Sara / Cleary, Sean / Gallinger, Steven / Greig, Paul D / McGilvray, Ian / Wei, Alice / Asa, Sylvia L / Ezzat, Shereen. ·Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. ·Cancer Med · Pubmed #24403235.

ABSTRACT: Pancreatic neuroendocrine tumors (pNETs) are the second most common pancreatic neoplasms, exhibiting a complex spectrum of clinical behaviors. To examine the clinico-pathological characteristics associated with long-term prognosis we reviewed 119 patients with pNETs treated in a tertiary referral center using the WHO 2010 grading and the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging systems, with a median follow-up of 38 months. Tumor size, immunohistochemistry (IHC) profiling and patient characteristics-determining stage were analyzed. Primary clinical outcomes were disease progression or death. The mean age at presentation was 52 years; 55% were female patients, 11% were associated with MEN1 (multiple endocrine neoplasia 1) or VHL (Von Hippel-Lindau); mean tumor diameter was 3.3 cm (standard deviation, SD) (2.92). The clinical presentation was incidental in 39% with endocrine hypersecretion syndromes in only 24% of cases. Nevertheless, endocrine hormone tissue immunoreactivity was identified in 67 (56.3%) cases. According to WHO 2010 grading, 50 (42%), 38 (31.9%), and 3 (2.5%) of tumors were low grade (G1), intermediate grade (G2), and high grade (G3), respectively. Disease progression occurred more frequently in higher WHO grades (G1: 6%, G2: 10.5%, G3: 67%, P = 0.026) and in more advanced AJCC stages (I: 2%, IV: 63%, P = 0.033). Shorter progression free survival (PFS) was noted in higher grades (G3 vs. G2; 21 vs. 144 months; P = 0.015) and in more advanced AJCC stages (stage I: 218 months, IV: 24 months, P < 0.001). Liver involvement (20 vs. 173 months, P < 0.001) or histologically positive lymph nodes (33 vs. 208 months, P < 0.001) were independently associated with shorter PFS. Conversely, tissue endocrine hormone immunoreactivity, independent of circulating levels was significantly associated with less aggressive disease. Age, gender, number of primary tumors, and heredity were not significantly associated with prognosis. Although the AJCC staging and WHO 2010 grading systems are useful in predicting disease progression, tissue endocrine hormone profiling provides additional information of potentially important prognostic value.

13 Article Planned versus unplanned portal vein resections during pancreaticoduodenectomy for adenocarcinoma. 2013

Kim, P T W / Wei, A C / Atenafu, E G / Cavallucci, D / Cleary, S P / Moulton, C-A / Greig, P D / Gallinger, S / Serra, S / McGilvray, I D. ·Hepatopancreatobiliary Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. ·Br J Surg · Pubmed #23939847.

ABSTRACT: BACKGROUND: The management of portal vein (PV) involvement by pancreatic adenocarcinoma during pancreaticoduodenectomy (PD) is controversial. The aim of this study was to compare the outcomes of unplanned and planned PV resections as part of PD. METHODS: An analysis of PD over 11 years was performed. Patients who had undergone PV resection (PV-PD) were identified, and categorized into those who had undergone planned or unplanned resection. Postoperative and oncological outcomes were compared. RESULTS: Of 249 patients who underwent PD for pancreatic adenocarcinoma, 66 (26·5 per cent) had PV-PD, including 27 (41 per cent) planned and 39 (59 per cent) unplanned PV resections. Twenty-five of 27 planned PV resections were circumferential PV-PD, whereas 25 of 39 unplanned PV resections were partial PV-PD. Planned PV resections were performed in slightly younger patients (mean(s.d.) 60(9) versus 65(10) years; P = 0·031), and associated with longer operating times (mean(s.d.) 602(131) versus 458(83) min; P < 0·001) and more major complications (26 versus 5 per cent; P = 0·026). Planned PV resections were associated with a lower rate of positive margins (4 versus 44 per cent; P < 0·001) despite being carried out for larger tumours (mean(s.d.) 3·9(1·4) versus 2·9(1·0) cm; P = 0·002). There was no difference in survival between the two groups (P = 0·998). On multivariable analysis, margin status was a significant predictor of survival. CONCLUSION: Although planned PV resections for pancreatic adenocarcinoma were associated with higher rates of postoperative morbidity than unplanned resections, R0 resection rates were better.

14 Article Molecular characteristics of a pancreatic adenocarcinoma associated with Shwachman-Diamond syndrome. 2013

Dhanraj, Santhosh / Manji, Arif / Pinto, Dalila / Scherer, Stephen W / Favre, Helen / Loh, Mignon L / Chetty, Runjan / Wei, Alice C / Dror, Yigal. ·Cell Biology Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. ·Pediatr Blood Cancer · Pubmed #23303473.

ABSTRACT: BACKGROUND: Shwachman-Diamond syndrome (SDS) is characterized by hypoplasia of the bone marrow and exocrine pancreas and a high risk of leukemia. It is unknown whether solid tumors are part of the disease phenotype. PROCEDURE: We performed copy number alterations using Affymetrix human SNP 6.0 array. Furthermore, we did direct sequencing of pancreatic cancer-related genes and immunohistochemical expression of selective proteins. RESULTS: Among 41 patients with SDS who enrolled on the registry, we identified one male patient with a solid tumor: moderately differentiated pancreatic ductal adenocarcinoma. The tumor harbored 41 copy number alterations (CNAs) and had no regions of loss of heterozygosity (LOH). None of these CNAs were exclusive to the tumor. One copy of the tumor suppressor genes CTNNA3 and LGALS9C was lost in both the peripheral blood and tumor. Direct sequencing of TP53, KRAS, and NRAS revealed no mutations. Immunohistochemical staining for cyclin D1, E-cadherin, p53 MLH1 and MSH2 and β-catenin, was similar to that seen in non-hereditary pancreatic cancer. CONCLUSIONS: Our case raises the possibility that solid tumors are associated with SDS, thereby broadening the clinical phenotype of the disease. The relatively young age at cancer diagnosis and the specific involvement of the pancreas make the possibility of an association with SDS likely. Similar to leukemia in SDS, the pancreatic cancer developed in hypoplastic tissues. This observation and the relative genomic stability of the tumor strengthen the hypothesis of improved adaptation of malignant clones among a population of disadvantaged cells as a mechanism for tumor expansion in SDS.

15 Article Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. 2012

Fox, Adrian M / Pitzul, Kristen / Bhojani, Faizal / Kaplan, Max / Moulton, Carol-Anne / Wei, Alice C / McGilvray, Ian / Cleary, Sean / Okrainec, Allan. ·Division of General Surgery, University Health Network, 10E212 Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. adrianmfox@gmail.com ·Surg Endosc · Pubmed #22179451.

ABSTRACT: BACKGROUND: The cost implications of laparoscopic distal pancreatectomy (LDP) and a detailed breakdown of hospital expenditures has not been presented in the literature to date. This study aimed to compare hospital costs and short-term clinical outcomes between LDP and open distal pancreatectomy (ODP). METHODS: The authors evaluated all the distal pancreatic resections performed at their center between January 2004 and March 2010. Parametric and nonparametric statistical analysis was used to compare hospital departmental and total hospital costs as well as oncologic and surgical outcomes. RESULTS: A total of 118 cases (42 laparoscopic resections, including 5 conversions, and 76 open resections) were analyzed. The demographic characteristics were similar between the groups except for a predominance of females in the laparoscopic group (P = 0.036). The indications for surgery differed by a paucity of malignant tumors being approached laparoscopically (P < 0.001). Intraoperatively, there were no differences in estimated blood loss, operating room time, or transfusion requirement. The pathologic outcomes did not differ significantly. The median hospital length of stay (LOS) was 5 days (range 3-31 days) for the LDP cohort and 7 days (range 4-19 days) for the ODP cohort (P < 0.001). Postoperative pancreatic fistula occurred for 22 patients, with a higher proportion observed in the LDP group (28.57%; n = 12) than in the open group (13.16%; n = 10; P = 0.05). However, the rates for grade B and higher grade fistula were higher in the ODP group (0 LDP and 4 ODP). The median preadmission and operative costs did not differ significantly. The ODP cohort had significantly higher costs in all other hospital departments, including the total cost. CONCLUSION: LDP is both a cost-effective and safe approach for distal pancreatic lesions. This series showed a shorter LOS and lower total hospital costs for LDP than for ODP, accompanied by equivalent postoperative outcomes.

16 Article Serous cystadenomas of the pancreas: long-term follow-up measurement of growth rate. 2011

Menard, Alexandre / Tomlinson, George / Cleary, Sean / Wei, Alice / Gallinger, Steven / Haider, Masoom A. ·Department of Medical Imaging, St Michael's Hospital, Toronto Ontario, Canada. ·Can Assoc Radiol J · Pubmed #20494547.

ABSTRACT: PURPOSE: To measure the growth rate of microcystic subtype serous adenomas of the pancreas diagnosed by imaging. METHODS: For this retrospective study, 241 imaging studies were reviewed from 1998 to 2005. Thirty-one patients met our strict diagnostic imaging inclusion criteria and had at least 18 months of imaging follow-up. Patient demographics and lesion imaging characteristics were tested as predictors of growth. RESULTS: Growth was measured over a mean period of 42 months. There was a significant (P = .0004) linear growth of tumour for the population. There was significant clustering (P = .001) of the population into 2 growth rates: 0.50 mm/y (n = 23) and 5.5 mm/y (n = 8). The diameter of the lesion at presentation was significantly correlated with growth (r = 0.45; P = .01). CONCLUSION: The microcystic subtype of serous cystadenomas of the pancreas diagnosed with imaging criteria demonstrates 2 distinct and slow growth rates. The size of the lesion at presentation is correlated with growth rate.

17 Article Sociodemographics and comorbidities influence decisions to undergo pancreatic resection for neoplastic lesions. 2010

Sandroussi, Charbel / Brace, Chantelle / Kennedy, Erin D / Baxter, Nancy N / Gallinger, Steven / Wei, Alice C. ·Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. ·J Gastrointest Surg · Pubmed #20571928.

ABSTRACT: INTRODUCTION: Pancreatic resection is being performed with increasing frequency and safety. Technical outcomes and long-term survival for neoplastic lesions are well reported; however, reasons why patients do not undergo surgery for potentially resectable lesions are not well understood. The aim of this study was to determine the factors contributing to the decision not to operate for resectable pancreatic neoplasms. METHODS: From 2004 to 2008, all patients with resectable pancreatic neoplasms at a single high-volume hepatopancreaticobiliary center were evaluated. The impact of patient factors, sociodemographics, medical comorbidities (Charlson combined comorbidity index (CCI) and ACCI), disease factors (tumor characteristics), and surgical factors (type of resection required) on the decision to undergo pancreatectomy were analyzed using univariate and multivariate binary logistic regression analysis. RESULTS: Three hundred seventy-five patients with resectable pancreatic lesions were identified. The median age was 62 years (21-93); 203 out of 375 (54.1%) were males. Fifty-five (14.7%) did not undergo resection. On univariate analysis, age (odds ratio (OR) 1.116, p < 0.001), non-English speaking background (NESB; OR 4.276, p = 0.001), tumor type (p = 0.001 increased for cystic neoplasms including intraductal papillary mucinous neoplasm), CCI score (OR 1.239, p = 0.001), and ACCI score (OR 1.433, p < 0.001) were associated with an increased risk of not undergoing resection. Gender, age, marital status, and urban residence were not predictive. On multivariate analysis, NESB (p = 0.018) and the ACCI (p = 0.002) remained predictive of not undergoing resection. The majority of patients did not undergo surgery because the patient declined in 25 out of 55 (45.5%), and resection was not offered in 15 out of 55 (27.3%). In the remainder, medical contraindications precluded surgery. Advanced age, tumor type, comorbidities (27.3%), age (21.8%), surgical risk (29.1%), frailty (18.2%), and uncertain diagnosis (5.5%) were cited as reasons for not proceeding with surgery. CONCLUSION: Patients with a higher ACCI and those from a NESB are less likely to undergo surgery for resectable neoplastic lesions of the pancreas. These factors must be taken into consideration in the decision-making process when considering surgery for patients with pancreatic neoplasms. Novel strategies should be employed to optimize access to surgery for patients with resectable pancreatic neoplasms.